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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4946

2. Registrant Information.

Registrant Reference Number: 100120640

Registrant Name (Full Legal Name no abbreviations): Farnam Companies, Inc.

Address: 301 W. Osborn Road

City: Phoenix

Prov / State: Arizona

Country: USA

Postal Code: 85013

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-150

Product Name: Repel-XP Emulsifiable Fly Spray

  • Active Ingredient(s)
      • Guarantee/concentration 1 %
      • Guarantee/concentration .4 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Animal / Usage sur un animal domestique

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On September 10, 2010 the owner sprayed the product onto the donkey's legs. The owner also applied another bug block product onto the donkey's legs that same day.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify Donkey

3. Breed

Domestic Donkey

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure



9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Irritated throat
    • Specify - Esophageal Ulcers
    • Symptom - Anorexia
  • General
    • Symptom - Lethargy
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On September 12, 2010 the donkey developed esophageal ulcers, anorexia, and lethargy. On September the owner took the donkey to the veterinarian, where an endoscopy was performed. Later that day, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated she would not expect any signs from a small oral exposure of the product. The APSS veterinarian recommended symptomatic care and calling back with questions.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here

The APSS veterinarian stated that the substance was not considered to be related to causing the clinical situation. A follow up was not performed, because additional information was not expected. On September 16, 2010 the owner called the APSS to update the case. The owner stated the attending veterinarian had prescribed ranitidine, omeprazole, and sucralfate. The owner stated that the donkey seemed to deteriorate after the sucralfate was given and the donkey died on September 15, 2010. The APSS veterinarian stated that it is very unlikely that a reaction from sucralfate caused the death. The owner also stated the attending veterinarian had performed a gross necropsy and a cause of death was undetermined.